Creating Cultural Student Learning Experiences in a Pro Bono Clinic
Purpose: To illustrate unique educational opportunities to increase cultural awareness through experiential service learning in a full-time pro bono clinic (PBC) integrated in a Doctorate of Physical Therapy (DPT) curriculum. Description: Chronic musculoskeletal pain (CMP) affects over 100 million people in the United States (US) and drives health seeking behavior in outpatient clinics. Gender, culture, and socioeconomic differences significantly impact the CMP experience, in part because it is an invisible disease. With poor correlation to imaging, CMP management hinges on clinical communication. Implicit healthcare provider biases and discordant patient/provider assessment are common during encounters with under-represented populations. Shared decision making is negatively impacted by language and cultural divides. These challenges can leave patients at risk for further marginalization. PBCs can be a vital community-based health resource, particularly in states that did not accept the Patient Protection Affordable Care Act expansion. Research demonstrates positive outcomes when the community is involved. Additionally, to become a community-valued health resource, non-financial barriers related to patients’ perceptions of clinicians’ cultural acceptability and accommodation need to be minimized. The American Physical Therapy Association (APTA) members demographic profiles indicate that 88.5% of clinicians identify as white/non-Hispanic. In the US, minorities are one-third of the population, but are almost half of the patients without health insurance. Given the under-representation of cultural minorities within DPT classrooms, a university-based PBC may run the risk of not fully understanding or appreciating their community’s diverse needs. Summary of Use: First, proceeding the opening of High Point University’s Pro Bono Physical Therapy Clinic, community assessments were completed: a population survey in three languages (n=861), a survey of regional clinicians (n=51), and a survey of non-medical community leaders (n=12). Based on these results, a PBC clinic open 40-hours weekly, was designed. Over 400 patients with 30 countries of origin have been treated. With a community-valued clinic operational, the DPT curriculum was incorporated into the clinic. A hybrid series of courses (three semesters, DPT year 2) emphasizes biopsychosocial / social determinants of health, communication, and contemporary topics impacting the health system. Each semester, students work in the clinic cumulatively providing up to 4,336 patient care hours throughout the course series. Dynamic class-time provides opportunities to actively debate, engage, and connect with the complex topics impacting their patients’ experiences within the PBC. Importance to Members: Curricular integration of clinical and didactic education based on experiences in the PBC can provide students the unique opportunity to engage with diverse patient populations, to build cultural and sociopolitical awareness, and to prepare them to fulfill their future APTA Code of Ethics responsibilities as practicing clinicians.